FPIN's Help Desk Answers

Short-Term Antipsychotics for Alzheimer Disease

 

Am Fam Physician. 2018 Apr 1;97(7):online.

Clinical Question

Do patients with Alzheimer disease who are treated with short-term antipsychotics have a higher mortality rate than those not taking antipsychotics?

Evidence-Based Answer

Physicians should consider not using antipsychotics in patients with dementia. (Strength of Recommendation: A, based on a meta-analysis of randomized controlled trials [RCTs] and a cohort study.) Patients with dementia, including Alzheimer disease, who are treated with antipsychotics for any length of time have a higher mortality rate than those not taking antipsychotics.

Evidence Summary

A 2005 systematic review and meta-analysis of 15 RCTs of 10 to 26 weeks' duration compared mortality in patients 56 to 99 years of age who received atypical antipsychotics or placebo.1 Patients had Alzheimer disease, vascular dementia, mixed dementia, or primary dementia. Overall, 87% of patients had Alzheimer disease. Subgroup analysis did not find heterogeneity between trials of patients with Alzheimer disease and higher cognitive function (Mini-Mental State Examination score greater than 10) vs. lower cognitive function. Of the 5,110 patients, 1,757 were randomized to placebo and 3,353 were randomized to an atypical antipsychotic, including aripiprazole (Abilify), 2 to 15 mg per day; risperidone (Risperdal), 0.5 to 4 mg per day; quetiapine (Seroquel), 50 to 600 mg per day; and olanzapine (Zyprexa), 1 to 15 mg per day. In pooled analysis of all 15 RCTs, death was more common among patients receiving atypical antipsychotics (odds ratio = 1.5; 95% confidence interval [CI], 1.1 to 2.2; number needed to harm [NNH] = 83). Patients with Alzheimer disease were not analyzed separately from those with other causes of dementia.

A 2014 retrospective cohort study investigated short- and long-term mortality risk associated with antipsychotic use in outpatients 65 years and older who had dementia (n = 26,940).2 Risk was assessed over multiple timeframes and for multiple antipsychotics. Patients had records in the Norwegian

Author disclosure: No relevant financial affiliations.

Address correspondence to Robert Martin, DO, at robert.martin@advocatehealth.com. Reprints are not available from the authors.


Copyright © Family Physicians Inquiries Network. Used with permission.

References

1. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294(15):1934–1943.

2. Langballe EM, Engdahl B, Nordeng H, Ballard C, Aarsland D, Selbæk G. Short- and long-term mortality risk associated with the use of antipsychotics among 26,940 dementia outpatients: a population-based study. Am J Geriatr Psychiatry. 2014;22(4):321–331.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Help Desk Answers published in AFP is available at http://www.aafp.org/afp/hda.

 

 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Dec 1, 2018

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article